To the Editor.—
Dr Knaus' editorial (1983;249:1059) covering uncertainties about the impact of intensive care units (ICUs) hits the target squarely—"not a single scientific study claiming that, by itself, intensive care unit support cures any disease." He reasonably suggests an approach by "rigorous selective study of acutely ill patients, through the prospective identification of important physiological indicators." Beyond this, however, not a single scientific study has investigated whether ICU support actually harms some patients, since it is clear that invasive instrumentation per se has this potential.1In essence, Dr Knaus appropriately considers the ICU itself to be a form of treatment. I think his objectives, shared by all of us—essentially determination of risk-benefit ratios—can best be approached by the most scientific and ethical method of getting an answer about any kind of treatment: a prospective randomized, controlled therapeutic trial.2 One method for doing this would be to have
Spodick DH. Can the Intensive Care Unit Be Harmful? JAMA. 1983;250(7):897. doi:10.1001/jama.1983.03340070015007
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